Senator Douglas McClelland (NEW SOUTH WALES)
- This Bill stems from the Government's budgetary proposals relating generally to nursing homes, to home nursing, aged persons homes and aged persons hostels. According to the Budget proposals, the total cost of the proposals mentioned in the Budget Speech of the Treasurer (Mr Snedden) is estimated to be $1 6.9m for the rest of this financial year and $43 .9m in a full year. Last week the Senate passed a Bill relating to this Bill, namely, the Aged Persons Hostels Bill. It was estimated that expenditure under the Aged Persons Hostels Bill could exceed $5m in the first full year of operation but, because it is considered that an initial period is necessary for planning projects and for calling tenders, expenditure this financial year is not expected to exceed $2m.

The Aged Persons Homes Bill which is now before us provides for an increase in the rate of personal care subsidy payable under the Aged Persons Homes Act. The Bill provides for the rate to be increased from $5 to $10 a week and that rate applies to each resident aged 80 years and over who is residing in an approved hostel. Under this Bill the personal care services must be provided for any aged resident in need of such services whether or not that resident has attained 80 years of age. The Attorney-General (Senator Greenwood) said during the course of his second reading speech when presenting this Bill that the present subsidy of $5 is now paid to 360 homes which cater for about 16,000 aged persons. Of those residents almost 7,000 are aged 80 years or over. The Minister said that expenditure on the subsidy currently is running at the rate of $2m a year and that doubling of the payment from $3 to $10 a week will cost an extra SI. 3m for the rest of this financial year and approximately $2m in the first full year. I rather suspect, Mr President, that that figure is in the nature of an estimate because it results from a mere doubling of the sum presently paid for those who are 80 years of age and over. Surely the personal care services to be provided for any aged resident in need of them, whether that person has attained 80 years of age or not must be taken into consideration also in estimating what the cost is likely to be.

Relating this Bill to the Aged Persons Hostels Bill which was dealt with last week, 1 was very interested to compare the second reading speech of the Minister for Social Services (Mr Wentworth) when presenting the Aged Persons Hostels Bill in the other place with the second reading speech on that Bill made in this place. I say that because the Minister for Social

Services, in the course of his second reading speech on the Aged Persons Hostels Bill in the other place, said:

However, because an initial period is necessary for planning projects and calling for tenders, expenditure is not expected to exceed $2m in 1972-73, but it is my sincere hope-

I emphasise these words to indicate that they were not included in the second reading speech of the Attorney-General in this chamber - that these estimates will prove to be over conservative.

It is very significant to me that that last phrase was omitted from the AttorneyGeneral's speech when moving the second reading of the Aged Persons Hostels Bill in the Senate. Apparently the Government now has made up its mind that this will be the amount. When the Bill was in the other place the Minister virtually said that he did not know the estimate of cost or that he did not know that the estimate of cost given was an accurate one. Indeed the estimate proposed for all these measures is more in the nature of a 'guesstimate' than a reasonable estimate.

I wish specifically to deal with this Aged Persons Homes Bill. Naturally one assumes that during this session a Bill will be introduced to amend the National Health Act in order to provide for the new arrangements for patients requiring home nursing care which are to take effect from 1st January of next year and the domiciliary care benefits which will commence from 1st March 1973. It appears to me that a great deal of this legislation could be incorporated within one type of legislation. The number of legislative measures relating to these aspects of health and welfare are creating great confusion in the minds of the people. People are confused about their entitlements. There is the home nursing legislation, which comes within the purview of the Commonwealth Department of Health, and the Aged Persons Homes Act and the Aged Persons Hostels Act, all of which are inter-related, the latter 2 not coming within the purview of the Commonwealth Department of Health but within the ambit of the Department of Social Services. It is high time that the Government gave consideration to this aspect wilh a view to seeing whether an effective consolidation of these pieces of legislation can be brought about.

Because the Aged Persons Homes Act will come into force on the first day after the Bill receives the royal assent, which I should think would be in the very near future, and having regard also to the fact that the Minister has said that departmental surveys show that many aged people who have no real need for medical supervision have been admitted to nursing homes - the reliable estimate that he cited during his second reading speech on the legislation was 25 per cent or about 12,000 - it seems to me that the Government should have introduced the amendments to the National Health Act before this legislation was introduced in order to make effective its policy on home nursing care. But for some reason which is beyond my comprehension the Government decided not to do that. I should have thought that the proposed amendments to the National Health Act in relation to home nursing care and domiciliary services should have been presented to the Parliament before this legislation. Certainly one can expect that when those amendments are introduced many people who now occupy places in aged persons homes might be able to return to their own home or to some other suitable place and that the procedure involved under that legislation should enable costs to be reduced and ensure that the elderly citizens of this country have the best of care in an environment to which they have been accustomed or which is more suitable for their needs and requirements.

Last week when the Aged Persons Hostels Bill was before the Senate the Democratic Labor Party said something about the differential in rates in the various States. I think Senator Gair was probably directing his attention to the home nursing legislation which is to be enacted under the National Health Act. The proposed rate of benefit will be the same in New South Wales, Queensland and Tasmania, namely, $10.50 a week; in Western Australia it will be $11.20 a week; in South Australia it will be $14 a week; and for Victoria it will be $22.40 a week - more than a 100 per cent increase on the rate of benefit to apply in New South Wales, Queensland and Tasmania and exactly 100 per cent more than the rate to apply in Western Australia. If I may mention these matters in relation to the Aged Persons Homes Bill, with which they are very much interrelated, I do not regard that sort of differential between the States as in any way satisfactory from a national point of view. I believe that an inquiry should be conducted by the Commonwealth Department of Social Services or the Commonwealth Department of Health into the reasons for the vast differential in the charges in the various States.

Perhaps the Minister could say in bis reply, if he chooses to do so, whether the charges are related to the law of supply and demand applying to the availability of beds in the various States. In other words, does it mean that some States are building more nursing homes for the people who need them than are other States where this area of activity has been left more to private enterprise? The States Grants (Nursing Homes) Act was passed by the Commonwealth Parliament during 1969 for the purpose of providing financial assistance to the States towards the erection of additional State-run nursing homes and extensions to existing homes. Commonwealth grants under the States Grants (Nursing Homes) Act are limited to $5m on a $1 for $1 basis and were made available for a period of 5 years. Whilst it might be pleaded by the Minister that this is not directly connected with this legislation, nonetheless I am sure he will agree that the matters are very much interwoven.

Senator Greenwood
- They are certainly interwoven. Unfortunately the Department of Health is responsible for nursing homes and the Department of Social Services is responsible for this measure. It is one of the practical problems in responding as much as I would have liked.

Senator Douglas McClelland (NEW SOUTH WALES)
- I come back to my earlier point. Because of the difficulty brought about by variations between the Department of Health and the Department of Social Services, I think the time is long overdue when the Government should consider how the various measures relating to the welfare of Australia's elderly citizens can be consolidated.

Senator Greenwood
- These pieces of legislation are a very marked breakthrough. That is the important thing about them.

Senator Douglas McClelland (NEW SOUTH WALES)
- I agree that they are a breakthrough, but I am not saying that they go far enough. I sat as a member of the Senate Select Committee on Medical and Hospital Costs and I agree that this legislation is a breakthrough. However, because of the diversity of areas that are involved, people become confused as to whom they should approach and what their entitlements are under this great multiplicity of legislation. As I was saying, I had the honour with my colleagues Senator Mulvihill and Senator Fitzgerald on this side of the chamber to be a member of the Wedgwood Senate Committee which inquired into medical and hospital costs.

Senator Douglas McClelland (NEW SOUTH WALES)
- Senator Dittmer, and Senator Sim, also were members of that Committee, which tendered its report to the Senate in June 1970. In dealing with this type of matter the Committee reported at page 57 of its report:

The Committee, whilst appreciating that it has been said that this is only the commencement of the scheme, believes that much more Commonwealth involvement and initiative is required. The Committee believes that a far greater number of homes are required in a relatively short period of time, and, in order that the criticisms concerning quantum of charges be kept in proper perspective, considers that these homes should be erected by the State authorities and be managed or be controlled in management by the States.

Whereas in the hospital field the States have taken responsibility for provision of services they have, as a general rule, left the development of nursing homes to private and religious bodies. Because of the relationship between hospitals and nursing homes, as mentioned in subsequent paragraphs, it appears to the Committee that it is unfortunate that the States have not undertaken extensive development of nursing homes. For this purpose and as a means of overcoming shortages of bed availability and possibly the stabilising of charges the Committee proposes that following a survey of needs the Commonwealth should make unmatched grants to the States while the need exists.

The table set out in paragraph 192 above shows the availability of approved nursing home beds, the difference in States between public and private ownership and how the States generally have maintained hospital services but not nursing homes. It is interesting to note that those States with higher hospital bed-population ratio generally have a higher ratio of nursing home beds to population.

The Committee of Inquiry into Health Insurance, known as the Nimmo Committee, had something to say on this subject at page 57 of its report which was presented in March 1969. For the sake of the record I will read out paragraphs 15.10 to 15.15: 15.10 The Commonwealth has recently introduced a higher scale of benefits for patients requiring intensive care. 15.11 This new benefit of $5 a day should greatly assist patients who are eligible for it. and at the same time, allow them to receive a better standard of care, provided the proprietors of the homes do not increase their charges so as to absorb the benefits, without improving the standard of care. Patients who require only light care are not eligible for the new benefit and their financial problems remain for them to resolve as best they can. 15.12 It was repeatedly stated in evidence before the Committee that the standard of accommodation and care in nursing homes varies greatly. It was stated that in some homes the accommodation is of the highest order and programmes of geriatric and rehabilitative treatment have been developed. In others, however, it was said that the accommodation is poor, the food unattractive and monotonous, the treatment almost solely confined to the administration of drugs and a large proportion of the patients becomes prematurely moribund and remains bedridden until the end. 15.13 Although the standard of accommodation and care provided by nursing homes may not come directly within our terms of reference we feel it incumbent on us to stress the urgent need for the Commonwealth Government and the State Governments to jointly investigate all aspects of nursing home services with a view to joint remedial action where necessary. 15.14 The need for Commonwealth-State cooperation in a simple matter of terminology was mentioned to us many times during the inquiry. It was stated that the dissatisfaction felt by insured persons who were accommodated in nursing homes, but received no fund benefits, was aggravated by reason of their nursing homes being registered under State laws as 'hospitals'. Because they were so designated, the insured persons believed that hospital benefits should have been available to help meet the accommodation charges. Whatever inquiries amd discussions are necessary before other nursing home problems are dealt with, there seems no reason why steps cannot be taken immediately to end the confusion and misunderstandings which occur because the expression 'hospital' means one thing to Commonwealth authorities and health insurance organisations, and something different to some Slate authorities. 15.15 We recommend:

(i)
that the Commonwealth and the States jointly investigate all problems associated with nursing homes with a view to joint remedial action where necessary;

(ii)
that the States be requested to prohibit the inclusion of the word 'hospital' in the name of nursing homes and other institutions which are not eligible for hospital insurance benefits.

I deliberately read those paragraphs into the record to indicate that the Nimmo Committee had something to say on this matter in March 1969 and the Wedgwood Committee had something to say on this and related matters in June 1970; yet it has taken the Government this length of time to get around to doing something to ameliorate the problems of the elderly citizens of oar community.

However, I agree that what is being done is a breakthrough. The Opposition believes that the steps that are being taken now, oe the eve of a Federal election, are ones that should have been taken many years ago. Naturally, the Opposition does not oppose this legislation at all. Like the Government it is anxious to secure the early passage of this legislation because it is more than time something was done to ameliorate the shocking state of geriatric services in this country. 1 trust that in the future consideration will be given by the Government to co-operating with local government organisations on a regional basis to tackle this problem thoroughly, effectively and on a planned basis. But, for the time being, because this legislation is a step towards achieving planning to meet the geriatric requirements of this nation, the Opposition does not oppose the Bill; indeed, it supports its speedy passage.